Home Care Nurses' Knowledge and Attitudes Regarding Telehealth to Promote Medication Compliance among Older Adults.

Medication noncompliance among older adults is a persistent problem resulting in morbidity, hospital readmissions, and decreased quality of life. Home care nurses are in a key position to assist older adults to employ medication compliance strategies that are tailor-made to fit their individual needs and abilities. The purpose of this study was to understand the knowledge and attitudes of home care nurses regarding telehealth practices to promote medication compliance of older adult patients and their perceived readiness to do so. We employed a qualitative research approach using semi-structured interviews. Individual interviews were conducted via Teams platform for a maximum of 60 minutes. Participants were home care nurses who use telehealth technology to advance medication compliance strategies. Ten interviews were conducted. Several themes emerged from the data which suggested home care nurses accept telehealth technology, are supportive of its continued use, and are willing to be educated on future advances in this technology to assist older adults with medication compliance strategies. Universities and home care agencies must provide opportunities to prepare nurses to utilize telehealth technologies to promote medication compliance among older adult home care patients.

Global Rehabilitation Health Worker Certification: Global Agenda, Local Imperative.

Rehabilitation, seen as a disability-specific service needed only by few of the world's population, has not been prioritized in countries and is under-resourced. A rehabilitation-ready health workforce is potentially the most important resource for improving functioning and the quality of life for the 2.41 billion people worldwide needing this care. In April 2019, CGFNS International, Inc., and the Association of Schools Advancing Health Professions (ASAHP) partnered to respond to the World Health Organization's Rehab 2030, which emphasizes the need for global action by professional organizations, development agencies, and civil society to develop and maintain a sustainable workforce for rehabilitation under different healthcare models in different economies. The global certification framework presented in this article provides a mechanism to validate rehabilitation knowledge and practice competence of individual health workers. The impact of certification on upgrading rehabilitation education and upskilling the world's rehabilitation health workforce cannot be overstated.

A Structured Immersion Approach to Approaching Interprofessional Education.

BACKGROUND: Interprofessional education (IPE) must explore the interdependency between healthcare professionals and ensure that IPE learning experiences are rooted in sound teaching and learning theories. Embedding IPE experiences into curricula using an incremental progression rather than "add-on" or "one-and-done" experience provides for continuous development of interprofessional competence by students as part of the learning process. Employing a school-wide structured immersion approach, over a 2-year period, incorporating five core IPE experiences designed to incrementally engage students in deeper, community-rich, person-centered learning experiences that are meaningful and sustainable. METHODS: An exploratory mixed-methods approach to collected data during the 2018-2019 academic year of the Core Signature IPE Experiences was employed (I-V). As part of the program review process, students were asked to voluntarily provide anonymous feedback after completion of each Core. Quantitative data was collected using Interdisciplinary Education Perception Scale (IEPS). Qualitative data were obtained from responses to open-ended questions added to the demographic component of the survey. The open-ended questions were designed to support, explain, and provide depth to the quantitative section. An elemental coding method was used to preliminarily review the corpus and generate descriptive codes and themes. Descriptive codes summarize in a word or short phrase the basic topic of a qualitative passage. RESULTS: Quantitative data of IEPS scores demonstrated students' mean scores in high range for each subscale at Core II (5.15) and slightly positive trend observed across three remaining Cores with Core V displaying highest mean score (5.44). From the qualitative survey, descriptive codes were agreed upon by two reviewers as providing the essence of response topic. Qualitative themes support and provide insight into quantitative data. CONCLUSIONS: Recognizing the interdependency which exits between professionals and developing trust and mutual respect among disciplines is paramount to ensuring evidence-based, person-centered healthcare. Infusing IPE learning experiences in the academy can play an important role in student development; however, IPE experiences must be rooted in learning theory. Program review findings from the Core Signature structured immersion experiences used across six health professions offers insight and a sound direction for health profession programs seeking to design IPE experiences that will aid in elevating the standard of healthcare and improving patient outcomes, by creating a collaborative ready workforce.

An exploration of higher-level language comprehension deficits and factors influencing them following blast TBI in US veterans.

PRIMARY OBJECTIVE: The objective of this study was to investigate the factors that might have a negative influence on auditory processing and higher-level language processing in the US veterans of the recent foreign wars (Iraq and Afghanistan). RESEARCH DESIGN: Exploratory, cross-sectional, correlational, prospective, cohort-design. METHODS AND PROCEDURES: The experimental group consisted of 12 US veterans of war (10 males and 2 females) with blast exposure. The control group consisted of six US veterans (5 males and 1 female) without the history of blast exposure. Both groups were matched in mean age. Both groups were tested on Boston Assessment of Traumatic Brain Injury, Consonant Trigrams Test, Symbol Digit Modality Test, Trail Making Test, SCAN-3, CELF-5-Metalinguistics, CASL, and an unpublished test on the processing of sentence prosody. MAIN OUTCOMES AND RESULTS: Significant group differences in attention, and time-compressed sentence processing were found. For those veterans (in the experimental group) who were not wearing their helmets at the time of blast, additional significant differences were noted with inferencing and auditory figure-ground tasks. CONCLUSIONS: Findings support the importance of including speech/language pathologists in all stages of recovery for veterans post-blast exposure.

An evidence-based approach to learning clinical anatomy: A guide for medical students, educators, and administrators.

The amount of information that medical students learn is voluminous and those who do not use evidence-based learning strategies may struggle. Research from cognitive and educational psychology provides a blueprint on how best to learn science subjects, including clinical anatomy. Students should aim for high-cognitive learning levels as defined in the SOLO taxonomy. Using a real-world example from a modern clinical anatomy textbook, we describe how to learn information using strategies that have been experimentally validated as effective. Students should avoid highlighting and rereading text because they do not result in robust learning as defined in the SOLO taxonomy. We recommend that students use (1) practice testing, (2) distributed practice, and (3) successive relearning. Practice testing refers to nonsummative assessments that contain questions used to facilitate retrieval (e.g., flashcards and practice questions). Practice questions can be fill-in, short-answer, and multiple-choice types, and students should receive explanatory feedback. Distributed practice, the technique of distributing learning of the same content within a single study session or across sessions, has been found to facilitate long-term retention. Finally, successive relearning combines both practice testing and distributed practice. For this strategy, students use practice questions to continue learning until they can answer all of the practice questions correctly. Students who continuously use practice testing, distributed practice, and successive relearning will become more efficient and effective learners. Our hope is that the real-world clinical anatomy example presented in this article makes it easier for students to implement these evidence-based strategies and ultimately improve their learning. Clin. Anat., 2018. © 2018 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

Reliability of Electrodermal Activity: Quantifying Sensory Processing in Children With Autism.

OBJECTIVE: We established test-retest reliability of electrodermal markers used to quantify physiological response to sensation using the Sensory Challenge Protocol in children with and without autism spectrum disorder (ASD). METHOD: Electrodermal activity (EDA) was measured during rest and in response to sensory inputs. Fourteen children with ASD and 18 typically developing children were tested and retested after 2-6 wk on skin conductance response, skin conductance level, nonspecific skin conductance response, and habituation. RESULTS: Test-retest reliability was evaluated with intraclass correlation coefficients (ICCs). Rest-phase coefficients for both groups were moderate (.65-.73). ICCs during response to sensation ranged from moderate to good for amplitude (.60-.81) and magnitude (.50-.75). In addition, moderate to excellent reliability (.51-.93) was observed for nonspecific response measures. CONCLUSION: EDA measures are reliable physiological markers that can quantify response to sensation in children with and without ASD.

Development and Preliminary Reliability of the Functional Upper Extremity Levels (FUEL).

OBJECTIVE: The Functional Upper Extremity Levels (FUEL) is a new classification tool to assess a person's upper-extremity functional and physical performance after sustaining a stroke. The aim of this preliminary study was to develop the tool and determine its content validity and interrater reliability. METHOD: Forty-four licensed occupational therapists ranging in years of experience from 6 mo to 16 yr participated in this study. A two-phase study was conducted: (1) constructing the FUEL and determining its content validity and (2) ascertaining its interrater reliability. RESULTS: We found that the FUEL had initial content validity and substantial interrater reliability (Fleiss κ = .754). CONCLUSION: The FUEL can be a useful clinical and research tool in occupational therapy for the assessment and classification of upper-extremity function for people after stroke. Further studies with larger samples and comparison studies with other similar tools are required to support the tool's reliability and validity.

Integrating delegation into the undergraduate curriculum.

One of the essential practice skills for registered nurses (RNs) is the delegation of tasks. However, few experiences in RN educational programs directly address the development of delegation skills. Many RNs report not feeling confident in their ability to delegate appropriately upon completing their educational programs. Nurse educators must respond to the need to address delegation in undergraduate nursing curricula. This article describes research evaluating levels of knowledge of and confidence in the delegation process among newly graduated RNs, and explores options for teachable moments about delegation.

Perceptions of mentoring of full-time occupational therapy faculty in the United States.

The purpose of this study was to describe the occurrence, nature and perception of the influence of mentoring for full-time occupational therapy faculty members who are on the tenure track or eligible for re-appointment in the United States. An online survey was sent during 2010 September, the beginning of the academic year, to all 818 potential participants in the United States entry-level and doctoral programmes. Fifty six of 107 participants who met the criteria reported being in a mentoring relationship and positively rated their perception of the influence of mentoring on academic success and academic socialization. The response of all participants to open-ended questions describes preferred mentoring characteristics (providing information, support), benefits (having someone to go to, easing the stress) and challenges (not enough time, mentoring not valued). Findings inform current and potential faculty of the current state of mentoring. Administrators can use this information when designing mentoring opportunities, educating mentors and mentees about the mentoring process, arranging mentors/mentees release time for engaging in the mentoring process and finally, managing the mentor/mentee needs. The cross-sectional survey of the United States occupational therapy faculty limits generalizability yet paves the way for future studies to explore retention and recruitment of mentored faculty across countries.

Effects of constraint-induced movement therapy on gait, balance, and functional locomotor mobility.

PURPOSE: This study reports the secondary effects of a constraint-induced movement therapy (CIMT) protocol on spatial temporal parameters of gait, balance, and functional locomotor mobility in children with cerebral palsy. METHODS: Sixteen children (4-12 years old) participated in a 3-week CIMT program. Participants were tested on the first and last day of the CIMT program using the Standardized Walking Obstacle Course (SWOC), the Pediatric Balance Scale (PBS) and the GAITRite Gold system (CIR Systems, Inc, Havertown, Pennsylvania). RESULTS: Wilcoxon signed rank tests were used on all pre- and posttests. Only the spatial temporal parameters of cadence and velocity differed significantly, with 12 subjects displaying a faster cadence (P = .02) and 10 subjects displaying a faster velocity (P = .05). CONCLUSION: In this pilot study, CIMT was found to promote changes in 2 spatial temporal parameters of gait. However, no changes were noted in the participant's measures on the SWOC and PBS.

Coping self-efficacy as a predictor of adherence to antiretroviral therapy in men and women living with HIV in Kenya.

The purpose of this study was to evaluate the relationship between the coping self-efficacy (CSE) scale and adherence to HIV medication in men and women enrolled in a large HIV treatment program in Kenya. Data were collected from a sample of 354 volunteers attending Nazareth Hospital's nine satellite clinics located in parts of Nairobi, and the central province of Kenya. A social demographic survey, Adult Clinical Trials Group adherence questionnaire, and CSE scale were used to obtain information. Descriptive statistics and logistic regressions were performed to analyze data and to test study hypotheses. Females were less likely to be nonadherent than males: the odds of adherence for females were 3.7 of the odds of adherence for males. Controlling for gender, CSE was significant. Adherence to antiretroviral therapy can be partially explained by CSE. Efforts aimed at building self-efficacy are likely to improve and maintain adherence to HIV and other medication. Implications, limitations, and future directions are discussed.

Admission variables and academic success in the first year of the professional phase in a doctor of physical therapy program.

BACKGROUND: To date, there are no standard sets of admission criteria identifying an applicant's ability to succeed in an entry-level doctor of physical therapy (DPT) program. The purpose of this study was to determine if a relationship existed between preadmission variables and academic success, as measured by the physical therapy GPA in the basic sciences after the first professional year (PY1GPA). METHODS: The sample consisted of 63 students from three consecutive classes admitted to an entry-level DPT Program from fall 2002 through fall 2004. The preadmission variables included age, gender, degree status, pre-cumulative GPA, and prerequisite course GPA. The preadmission factors were correlated with the dependent variable of PYIGPA. In a second analysis, the resulting significant correlations (p < 0.05) were entered into a forward multiple regression analysis to determine the best predictors. RESULTS: The Spearman rho correlation coefficient indicated that the pre-cumulative GPA correlated positively to the PY1GPA in the basic sciences (r = 0.441, p < 0.01). After multiple regression analysis, it was revealed that pre-cumulative GPA and age accounted for 16.7 and 3.9%, respectively, of the total variance (20.6%) in PY1GPA in the basic sciences. CONCLUSION: Although this study did not address academic success throughout the length of the professional academic program, the findings offer insight regarding students' initial academic performance. Gaining insight into students' performance at this early stage in their education may provide a greater understanding of their potential success throughout the graduate program.

Does the mind map learning strategy facilitate information retrieval and critical thinking in medical students?

BACKGROUND: A learning strategy underutilized in medical education is mind mapping. Mind maps are multi-sensory tools that may help medical students organize, integrate, and retain information. Recent work suggests that using mind mapping as a note-taking strategy facilitates critical thinking. The purpose of this study was to investigate whether a relationship existed between mind mapping and critical thinking, as measured by the Health Sciences Reasoning Test (HSRT), and whether a relationship existed between mind mapping and recall of domain-based information. METHODS: In this quasi-experimental study, 131 first-year medical students were randomly assigned to a standard note-taking (SNT) group or mind map (MM) group during orientation. Subjects were given a demographic survey and pre-HSRT. They were then given an unfamiliar text passage, a pre-quiz based upon the passage, and a 30-minute break, during which time subjects in the MM group were given a presentation on mind mapping. After the break, subjects were given the same passage and wrote notes based on their group (SNT or MM) assignment. A post-quiz based upon the passage was administered, followed by a post-HSRT. Differences in mean pre- and post-quiz scores between groups were analyzed using independent samples t-tests, whereas differences in mean pre- and post-HSRT total scores and subscores between groups were analyzed using ANOVA. Mind map depth was assessed using the Mind Map Assessment Rubric (MMAR). RESULTS: There were no significant differences in mean scores on both the pre- and post-quizzes between note-taking groups. And, no significant differences were found between pre- and post-HSRT mean total scores and subscores. CONCLUSIONS: Although mind mapping was not found to increase short-term recall of domain-based information or critical thinking compared to SNT, a brief introduction to mind mapping allowed novice MM subjects to perform similarly to SNT subjects. This demonstrates that medical students using mind maps can successfully retrieve information in the short term, and does not put them at a disadvantage compared to SNT students. Future studies should explore longitudinal effects of mind-map proficiency training on both short- and long-term information retrieval and critical thinking.

Perspective from the practice committee: is autonomous practice in neurologic physical therapy defined differently based on the type of practice setting?

The answer to the question, "Is autonomous practice in neurologic physical therapy defined differently based on the type of practice setting?" is no. Autonomous practice is a characteristic of the physical therapist, embodying excellence, communication and collaboration, and advocacy and caring. It is our belief that many physical therapists already practice autonomously, even though they may not recognize their practice as being autonomous; and it is our hope that physical therapists who are functioning as autonomous practitioners will provide peer mentoring to help bring their colleagues to the same level of practice and the same recognition. The full position statement on autonomous practice is available on the Neurology Section Web site at http://www.neuropt.org/go/healthcareprofessionals/autonomous-practice.

The relationship between patient satisfaction and inpatient admissions across teaching and nonteaching hospitals.

The need for healthcare executives to better understand the relationship between patient satisfaction and admission volume takes on greater importance in this age of rising patient expectations and declining reimbursement. Management of patient satisfaction has become a critical element in the day-to-day operations of healthcare organizations pursuing high performance. This study is guided by two principal research questions. First, what is the nature of the relationship between patient satisfaction (as measured by scored instruments) and inpatient admissions in acute care hospitals? Second, does the relationship between patient satisfaction (as measured by scored instruments) and inpatient admissions differ between teaching hospitals and nonteaching hospitals? Although not suggestive of direct causation, the study findings revealed a statistically significant and positive correlation between patient satisfaction and admission volume in teaching hospitals only. In contrast, a nonsignificant, negative correlation was seen between patient satisfaction and admission in nonteaching hospitals. In the combined teaching and nonteaching sample, a statistically significant, negative correlation was found between patient satisfaction scores and admission volume. With financial performance being driven in part by admission volume and with patient satisfaction affecting hospital patronage, the business case for a strategic focus on patient satisfaction in teaching hospitals is clearly evident. The article concludes with a set of recommendations for strengthening patient satisfaction and organizational performance.

Interrater reliability of the mind map assessment rubric in a cohort of medical students.

BACKGROUND: Learning strategies are thinking tools that students can use to actively acquire information. Examples of learning strategies include mnemonics, charts, and maps. One strategy that may help students master the tsunami of information presented in medical school is the mind map learning strategy. Currently, there is no valid and reliable rubric to grade mind maps and this may contribute to their underutilization in medicine. Because concept maps and mind maps engage learners similarly at a metacognitive level, a valid and reliable concept map assessment scoring system was adapted to form the mind map assessment rubric (MMAR). The MMAR can assess mind map depth based upon concept-links, cross-links, hierarchies, examples, pictures, and colors. The purpose of this study was to examine interrater reliability of the MMAR. METHODS: This exploratory study was conducted at a US medical school as part of a larger investigation on learning strategies. Sixty-six (N = 66) first-year medical students were given a 394-word text passage followed by a 30-minute presentation on mind mapping. After the presentation, subjects were again given the text passage and instructed to create mind maps based upon the passage. The mind maps were collected and independently scored using the MMAR by 3 examiners. Interrater reliability was measured using the intraclass correlation coefficient (ICC) statistic. Statistics were calculated using SPSS version 12.0 (Chicago, IL). RESULTS: Analysis of the mind maps revealed the following: concept-links ICC = .05 (95% CI, -.42 to .38), cross-links ICC = .58 (95% CI, .37 to .73), hierarchies ICC = .23 (95% CI, -.15 to .50), examples ICC = .53 (95% CI, .29 to .69), pictures ICC = .86 (95% CI, .79 to .91), colors ICC = .73 (95% CI, .59 to .82), and total score ICC = .86 (95% CI, .79 to .91). CONCLUSION: The high ICC value for total mind map score indicates strong MMAR interrater reliability. Pictures and colors demonstrated moderate to strong interrater reliability. We conclude that the MMAR may be a valid and reliable tool to assess mind maps in medicine. However, further research on the validity and reliability of the MMAR is necessary.